Yamamoto M, Hibi H, Miyake K
Department of Urology, Nagoya University School of Medicine, Aichi, Japan.
Int J Urol. 1994 Mar;1(1):74-7. doi: 10.1111/j.1442-2042.1994.tb00013.x.
Prostate-specific antigen (PSA) is a kallikrein-like serine protease that is secreted exclusively by the epithelial cells of all types of prostatic tissue, benign and malignant. Its serum concentration is raised in men with prostatic disease including cancer. We have evaluated its usefulness in the diagnosis of prostate cancer by measuring serum PSA concentrations in 260 men aged 50 years or over. All had abnormalities at digital rectal examination (DRE) involving suspected cancer, signs and symptoms of benign prostatic hyperplasia and equivocal findings on DRE, and miscellaneous other conditions, including hematospermia, chronic prostatitis and microscopic hematuria. Transrectal prostatic needle biopsies were performed in the men with abnormal findings on DRE or elevated serum PSA (above 4 ng/ml). Serum PSA ranged from 4.0 to 9.9 ng/ml in 14 (5%) of the 260 men. Four of the men in this group (31%) who underwent prostatic biopsy had prostate cancer. Serum PSA levels greater than or equal to 10.0 ng/ml were found in 8 (3%) of the 260 men. 5 of these 8 (63%) who underwent prostatic biopsy had cancer. If DRE alone had been used to screen the men having biopsies, 4 of the 10 cancers (40%) would have been missed. If PSA alone had been used to screen these men, only 1 of the 10 cancers would have been missed. Serum PSA measurement was more reliable than DRE for detecting prostate cancer. Since these two methods do not always detect the same malignant tumor, the combined use of DRE and PSA testing affords a more complete evaluation of the prostate gland for malignant involvement.
前列腺特异性抗原（PSA）是一种类激肽释放酶的丝氨酸蛋白酶，由所有类型前列腺组织（良性和恶性）的上皮细胞特异性分泌。前列腺疾病（包括癌症）患者的血清PSA浓度会升高。我们通过检测260名50岁及以上男性的血清PSA浓度，评估了其在前列腺癌诊断中的作用。所有患者均在直肠指检（DRE）时发现异常，包括疑似癌症、良性前列腺增生的体征和症状以及DRE检查结果不明确，还有其他各种情况，包括血精症、慢性前列腺炎和镜下血尿。对DRE检查结果异常或血清PSA升高（高于4 ng/ml）的男性进行经直肠前列腺穿刺活检。260名男性中有14名（5%）的血清PSA范围为4.0至9.9 ng/ml。该组中接受前列腺活检的4名男性（31%）患有前列腺癌。260名男性中有8名（3%）的血清PSA水平大于或等于10.0 ng/ml。这8名接受前列腺活检的患者中有5名（63%）患有癌症。如果仅使用DRE对接受活检的男性进行筛查，10例癌症中有4例（40%）会被漏诊。如果仅使用PSA对这些男性进行筛查，10例癌症中只有1例会被漏诊。血清PSA检测在检测前列腺癌方面比DRE更可靠。由于这两种方法并不总是能检测到同一恶性肿瘤，联合使用DRE和PSA检测能更全面地评估前列腺是否存在恶性病变。
